Post-Enrollment National Accreditation Update

Organizational providers of NC Medicaid behavioral health, Intellectual and Developmental Disabilities (I/DD) and substance use services are reminded that achievement of national accreditation is required per:

• NC Gen Stat § 122C-81 (2023)
• NC Medicaid clinical coverage policies 
• The North Carolina Medicaid State Plan 
• National accreditation is also required as outlined in the Division of Mental Health, Developmental Disabilities and Substance Use Services (DMHDDSUS) State-funded Service Definitions. 

This requirement is referred to as post-enrollment accreditation, as it is required within either one or three years after the provider’s initial enrollment with their selected Service. Individual providers billing under their own individual National Provider Identifier (NPI) and taxonomy are not impacted by this change.

Providers delivering Innovations Waiver services included in Clinical Coverage Policy 8-P, North Carolina Innovations, in addition to Benefits Counseling, must be nationally accredited at the time of selecting and enrolling in an Innovations Waiver Service. Please see additional information in the previous bulletin titled, Innovations Waiver Providers – Updated Service and National Accreditation Requirements.

Providers with an active 251S00000X (Community/Behavioral Health Agency) taxonomy are advised to initiate the process of obtaining national accreditation if not already in process. Beginning April 20, 2026, NCTracks monitoring efforts for national accreditation under the 251S00000X taxonomy will be instituted to verify compliance with NC Gen Stat § 122C-81 (2023) and clinical coverage policy requirements.

Upcoming Provider Permission Matrix Changes

Beginning April 20, 2026, the Provider Permission Matrix (PPM) will be updated so that column DOES-SRVC-RQRE-ACCREDITATION (column AG) will be modified for taxonomy 251S00000X - Community/Behavioral Health Agency to inform: 

• whether national accreditation is required within one or three years of the initial enrollment with the selected SERVICE (column AF); and
• which providers need to gain national accreditation from one of the entities identified in the SERVICE-ACCREDITATION-TYP (column AI) within the timeline specified.

Existing Providers with active 251S00000X taxonomy – DEADLINE IMPOSED

Existing providers with an active 251S00000X taxonomy must ensure they are enrolled with at least one SERVICE-TYPE (column AE) and SERVICE (column AF) by Aug. 1, 2026, to avoid termination of the taxonomy and potentially the service location and provider record. Services may be added through the submission of a Manage Change Request (MCR) in NCTracks. 

The PPM will be updated April 20, 2026, to display the most current available Services and the criteria required to enroll with that Service. Existing providers with an active Service as of April 20, 2026, will have until April 20, 2027, to complete post-enrollment accreditation and add it to their NCTracks record, making it imperative to begin the process if not already in progress.

Providers enrolling with 251S00000X taxonomy

Beginning April 20, 2026: 

• Providers newly enrolling under taxonomy 251S00000X
• Providers adding taxonomy 251S00000X to their existing record 
• Providers adding a new Service under existing 251S00000X taxonomy

Provider must select a Service at the time of enrollment. The option to select taxonomy 251S00000X without a Service will no longer be permitted.

Selecting a Service begins the timeline to be accredited within either one or three years after initial enrollment with their selected Service, as indicated on the PPM. See the table below for additional information about the Services available.

Adding National Accreditation to NCTracks Record

Beginning April 20, 2026, providers with an active 251S00000X taxonomy who are already nationally accredited are strongly encouraged to complete an MCR to add the accreditation to their NCTracks provider record. This ensures early compliance with the post-enrollment requirement. If not added timely, the provider risks adverse action when the timeline for reporting national accreditation expires. 

In addition, providers must understand that national accreditation certification expiration dates are not automatically updated once added to the NCTracks record. Providers are required to update their national accreditation prior to expiration to avoid adverse action. 

For more information, see the How to Add or Update Licensing and Accreditation on the Provider Profile in NCTracks Job Aid.

Potential Adverse Actions

Failure to obtain the required post-enrollment national accreditation within the timeframes outlined in the table below will result in suspension of the Service-related claims from NCTracks and the contracted health plans. 

If action is not taken within the suspension period to add a national accreditation, the Service will terminate on the provider record which may lead to additional repercussions such as:

• termination of the taxonomy if there are no other active services;
• termination of the location if there are no other active taxonomies for that location; and/or
• termination of the provider record if there are no other active service locations.

The chart below shows when national accreditation is required for NC Medicaid Services under taxonomy 251S00000X, and which national accreditations are accepted for each Service.

Resources

• Provider Permission Matrix (the newest version of the PPM will be available on April 20, 2026)
• Permission Matrix Instructions Job Aid under Quick Links
• Medicaid Behavioral Health clinical coverage policies may be accessed at Program Specific Clinical Coverage Policies | NC Medicaid. 
• DMH/DD/SUS State-funded Services coverage policies may be accessed at NC DMH/DD/SUS: Service Definitions.
• Upcoming Layout Changes for PPM announcement may be accessed at NCTracks
• How to Add or Update Accreditation on the Provider Profile in NCTracks Job Aid

Contact

• NCTracks Call Center: 800-688-6696
• Provider Ombudsman: 866-304-7062